Weekly Update - July 31, 2011 - Week 6

Sunday, July 31, 2011

The Internal Medicine Residency newsletter is posted each week to share important news, announcements and updates about the residency program. Please contact Randy Heffelfinger or Emily Strollo with corrections, contributions and suggestions.

From the Director

 "It's good to be back! I had a great week of learning and networking at the AAIM Executive Leadership course in Boston - some long days of strategy, operations management and cost accounting, but definitely an outstanding group to learn with. I look forward to bringing back some of what I learned to our program.

Thanks to the chiefs, Eileen, Juliessa and Tony, as well as the Associate Program Directors and office staff for holding down the fort this past week! We started our second group of Stead Attendings (Steve Crowley and Tom Owens) on Duke Gen Med and continued with the noon conference emergency lecture series. The lecture series continues this week and we will end this part of our curriculum with Physical Exam Week, starting August 8th.

Looking further ahead we have an opportunity to participate in the Annual DUHS Patient Safety and Quality Conference, which will be held on December 17.  The current call for abstracts attached is soliciting abstract submissions for poster presentations at the conference, within areas of 1) patient safety, 2) process improvement and innovation, 3) education of patient safety or quality improvement, and 4) patient or family engagement.  Please submit your abstracts by October 7th, 2011.  The following attachment has all of the details.   Call for Abstracts 2011_Dec 15 (3)

Finally, GOOD LUCK to the second year med students on their shelf exam this week - its been fun having you on gen med! And congratulations to Meredith Edwards (PGY-1) on her engagement!

Have a great week!


What I Read This Week “WIRTW”  (submitted by Dave Butterly)

[box] "Desensitization in HLA-Incompatible Kidney Recipients and Survival”;  Robert A. Montgomery, M.D., D.Phil., Bonnie E. Lonze, M.D., Ph.D.,Karen E. King, M.D., Edward S. Kraus, M.D., Lauren M. Kucirka, Sc.M.,Jayme E. Locke, M.D., M.P.H., Daniel S. Warren, Ph.D.,Christopher E. Simpkins, M.D., M.P.H., Nabil N. Dagher, M.D.,Andrew L. Singer, M.D., Ph.D., Andrea A. Zachary, Ph.D.,and Dorry L. Segev, M.D., Ph.D. [/box]

This article appears in the July 28th NEJM. It reports on the results of a desensitization protocol in a cohort of highly allosensitized patients awaiting kidney transplant. These authors have a long track record of clinical trials and research in this area.


Kidney transplantation confers the best survival for patients with ESRD healthy enough to undergo transplant. Nearly 100,000 people in the US are awaiting kidney transplant. The waiting times can be prolonged particularly in our geographic area. Roughly 20-25% of those awaiting transplant are highly allosensitized. The development of these alloantibodies generally occurs due to transfusion, prior transplantation, or pregnancy. These patients who are allosensitized also have substantially longer waiting times and once transplanted suffer from higher rejection rates along with worse outcomes.

In this study, patients who were allosensitized were treated with a protocol including plasmapheresis and IVIG to desensitze them. 211 of 215 patients were able to obtain a negative cross match and move forward with transplantation. These 211 patients are reported on here and compared to a group of similarly sensitized patients on the UNOS list who were able to receive a kidney after prolonged wait (Dialysis or Transplant) and to a 3rd group who were wait listed but never obtained a kidney (Dialysis only). Survival among these groups is shown in Figure 1

Bottom Line:

As has been shown in prior studies, moving forward with transplant carried a significant survival benefit compared to dialysis. Those in the treatment group had the highest 1 yr, 3 yr, and 8 year survival (90%, 85.7%, 80%) compared to the dialysis only group (91%, 67%, 30%) and compared to the Dialysis-Transplant Group (93%, 77%, 49%). These data provide further evidence that desensitization protocols may help overcome incompatibility barriers and allow more patients to move forward with transplant.

Physical Exam Week

"Physical Exam Week" starts in August 8, just one week away.  If you have not all ready done so, please complete the online survey to help us prepare for the upcoming series.  So that you can also plan ahead, below is the preliminary schedule for reference.

Day Date Topic Lecturer
Monday 8/8 Physical Exam Week/ Head and Neck, inpt MICU Arcasoy/Simel/Govert
Tuesday 8/9 Physical Exam Week/Cardiovascular Arcasoy/Ward
Wednesday 8/10 Physical Exam Week/Neuro/Abdominal Arcasoy/Morganlander/Peyser
Thursday 8/11 Physical Exam Week/MSK/Thoracic Arcasoy/Rice/Zaas
Friday 8/12 Physical Exam Week/Inpatient/lymphatics/new patient Arcasoy/Zaas/Rubin


From the Chief Residents

Grand Rounds - Friday, August 5, 2011

Medicine Grand Rounds on Fri., Aug 5 at 8am in Duke Hospital room 2002 will feature Sana Al-Khatib, MD, MHS, associate professor of medicine (Cardiology).

Dr. Al-Khatib will lead a mortality and morbidity discussion on QTc prolongation. M&M conferences are limited to MD faculty in the Department of Medicine.

Noon Conference









Jeopardy The Chiefs


Simply Delicious



Approach to Anemia Murat Arcasoy





Lung Transplantation Scott Palmer





Inpatient CHF management Joseph Rogers



News from The Ambulatory Chief Resident

Ambulatory Clinic Schedule - it is easy to find your assignments - just log into MedHub, click on "View My Calendar" on the left side of your home page.

IMPORTANT: New Rules at the ACC starting on 8/1/11:

If your assignments take you to the ACC - please be aware of the following:

a) Sign-in sheet: At the start of each clinic session, residents must sign their initials on the schedule sheet located in the ACC Attending Room to track arrival to clinic.

b) Residents must check in with the ACC teaching attending prior to leaving at the end of their shift.

c) Please arrive on-time for the ACC morning lectures, start time: 7:30am

DOC NewsLetter - To find out what's new at the DOC, check out the July/August News Letter.

DOC Newsletter July-Aug 2011

Lets us know what you think of this format, and if you have items you would like to include, please let us know.

Step 3 Reminder

JARS  - if you have not all ready done so, it's time to schedule USMLE Step 3.  Our office is required to collect your USMLE Step 3 information.  This includes both the date(s) you are taking the exam and the results once they have arrived.  Note:  ALL PGY2' are required to take AND PASS this exam prior to being promoted to a PGY3.

Please send the date you have scheduled to take the exam to the attention of RHEA FORTUNE  (rhea.rortune@duke.edu)  as soon as it is available, who will notify the Chiefs in order that we can adjust rotation schedules accordingly.  For more information, please use the following link:      http://www.fsmb.org/usmle_apply.html


Upcoming Dates

  • August 12 - Liver Rounds at the Zaas' home (change of date)

From the Residency Office

Lab Coats - Rx Pads - Access to Gym/Bunker

Rx pads – Requests for additional Rx pads are to be directed to the GME office (684-3491). Once received our office will page you to let you know that they are available to be picked up. To be safe, please allow at least TWO WEEEKS for delivery. They are not available on short notice.

Lab Coats – At this time of year JAR’s and SAR’s are approved to pick up new lab coats. You do not need to stop by our office – or the GME office – for approval. Simply go to the book store in Duke S and request a replacement.  The book store maintains a list of names in our program that are eligible for replacements.

Gym/Bunker - The GME office confirmed with the Duke Card Office that the problem that our interns have had accessing the gym and bunker has been resolved. Give it a try, and thanks for your patience.

Employee Health and Wellness

Friday we contacted residents in the program who are NOT current on all of the required Health and Wellness tests. If you received the email – please bring everything up to date no later than Friday, August 5. 

[box]We have received a report from Employee Occupational Health and Wellness indicating who in our program is not 100% compliant with all of the required testing, which may include any of the following: Hep B Vaccine, PPD baseline, PPD Annual test, Respirator Clearance, Airborne Respirator Training, Fit test. The most frequent problem areas are TB testing and annual fit test.

What to do: First, check your status on the OESO website to determine which of the above are delinquent. http://www.safety.duke.edu/.   I also have a hard copy report in my office if you would like to stop by or call.

You can also contact EOHW directly regarding TB test and annual fit testing (contact information below) and you can complete annual respirator training on-line at www.safety.duke.edu.

Joan C. Catignani, Dr. P.H., Assistant Director, Occupational & Environmental Safety Office

joan.catignani@duke.edu ; Telephone: (919) 668-3201 [/box]

DHTS Help Desk

On Monday, August 1, the DoM IT group will begin using the DHTS help desk application for all new requests.   Should you require support, please use the following link to submit requests electronically:  http://www.dunk.duke.edu/submit/index.htm

Cycling in the Triangle

Despite the recent heat wave - and a week off - cycling will resume this weekend.

When - Sunday, 8:30, at Maureen Joy, 1955 W Cornwallis Road

Useful links